Experts: Data lacking on long-term IED effects

Feb. 20, 2014 - 05:28PM
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A medic attends to a wounded solider in the aftermath of an IED explosion in Afghanistan in 2012. New research is delving into the potential long-term health effects of exposure to such blasts. (AFP/Getty Images)

Troops injured by bomb blasts — who absorb the full brunt of a shock wave, are hit by flying debris or even exposed to bomb-making chemicals — are at higher risk for developing long-term health problems such as post-traumatic stress disorder, persistent headaches and some skin conditions, a panel of top scientists says.

In a report prepared for the Veterans Affairs Department and released Feb. 13, the Institute of Medicine reviewed past studies and reports on blast exposure to determine what long-term health consequences they may pose for veterans who were hit.

According to the panel, some conditions clearly can be linked to exposure, such as penetrating eye injuries and injuries to the urinary tract and genitalia.

Others, like PTSD and chronic headaches, were strongly associated with blasts. But some, including chronic traumatic encephalopathy — the brain disease implicated in the deaths of a number of NFL players and some service members — as well as hearing loss and osteoarthritis, showed a less direct link.

“Acute physical and psychological health outcomes in people who survive blast explosions can be devastating, but the long-term consequences are less clear, particularly for individuals who show no external signs of injury ... or may not even be aware they were exposed,” said Dr. Stephen Hauser, committee chair and head of the neurology department at the University of California San Francisco.

The report confirms what many in the military have long suspected: that concussions, or mild traumatic brain injury, related to blast exposures are linked to post-traumatic stress disorder.

Using advanced imaging technology, several studies, including a 2012 University of Rochester investigation, have found blast injury may “predispose” troops to PTSD.

Why that’s so is unknown. The IOM said it could be a result of the direct blast experience or “indirect exposure, such as witnessing the aftermath of a blast or being part of a community affected by the blast.”

“While there is substantial overlap between symptoms of mild TBI and PTSD, limited evidence suggests most of the shared symptoms could be a result of PTSD and not a direct result of TBI alone.”

To compile its report, the IOM panel reviewed more than 12,800 articles and abstracts on blast trauma and health outcomes. Yet the 17 panel members found that their ability to draw conclusions about links between exposure to blast and health effects, particularly long-term health effects, “was severely restricted by the paucity of high-quality information.”

The panel suggested that VA:

■ Conduct research to identify biomarkers of blast injury.

■ Support research on detecting, preventing and treating such injuries.

■ Create a registry of blast-exposed — not just blast injured — troops to serve as a foundation for long-term studies.

The panel also said the Defense Department should improve its real-time data collection to understand the scope and impact of blast incidents and consider screening recruits to determine their susceptibility to blast injury.

“Filling the data gaps is important for advancing the understanding of how blast affects humans in the short term and long term,” the IOM panel said. “Attention to those complexities has often been lacking in research studies.”